| NPI | 1285289744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2024-09-16 |