| NPI | 1407629629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT BBH-ACLC-LIC-64561) |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2023-10-31 |