NPI | 1316479132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 174400000X Specialist |
Enumeration Date | 2017-03-30 |
Last Update Date | 2022-05-26 |