| NPI | 1326238171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: LA MD200466) |
| Additional Taxonomies | 2086S0129X (Licence: MS 18022) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 200466) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2022-05-18 |