| NPI | 1306256185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: IL 036172434) |
| Additional Taxonomies | 2086S0129X (Licence: CA A183442) |
| 2086S0129X (Licence: NV 23484) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2024-10-29 |