| NPI | 1275277956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RA2025-0306) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2026-02-04 |