| NPI | 1407522683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 47629) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2025-0092) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2026-04-11 |