| NPI | 1386191658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: MA 2526) |
| Additional Taxonomies | 213ES0131X (Licence: PR 114) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-05 |
| Last Update Date | 2023-03-27 |