| NPI | 1285473777 |
|---|---|
| Other Name | CHARLIE SCOTT TANCULA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2024-05-23 |