| NPI | 1396064796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA C199614) |
| Additional Taxonomies | 2086S0129X (Licence: KY TP421) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2086S0129X (Licence: KY 52772) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2026-04-23 |