| NPI | 1386237014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 2597) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD j525135067032) |
| Enumeration Date | 2021-02-13 |
| Last Update Date | 2026-01-26 |