| NPI | 1275973950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT207634) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P29239) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2014-07-12 |