| NPI | 1336643907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-10887) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT221900) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-07-12 |