| NPI | 1316654346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2023-04-18 |