| NPI | 1306290226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085N0700X (Licence: PA OS022161) |
| 2085N0700X (Licence: WV 3914) | |
| Enumeration Date | 2016-04-17 |
| Last Update Date | 2022-10-04 |