| NPI | 1295181949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV IN0007654) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY I11797) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2016-05-12 |