| NPI | 1356505291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: VA 0101256304) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116022444) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2014-12-01 |