| 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 |