| NPI | 1376098459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO S036152019) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2024-05-14 |