| NPI | 1376961771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OR 167864) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2017-04-25 |