| NPI | 1346915378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 1346915378) |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2024-06-25 |