| NPI | 1376648113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ND 12336) |
| Additional Taxonomies | 2086S0129X (Licence: MN 104929) |
| 2086S0129X (Licence: MN 53267) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-03-29 |