| NPI | 1336633486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 293647) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11020165A) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-02-17 |