| NPI | 1285367888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| 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: WI 82502-20) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 77366) | |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2024-05-10 |