| NPI | 1396164208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: WA MD61457738) |
| Additional Taxonomies | 2085R0001X (Licence: ND 15829) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2025-09-12 |