| NPI | 1366184590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT022204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA 022204) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-08-05 |