| NPI | 1306605852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL D420-525-95-308-0) |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-03-18 |