| NPI | 1437348521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 132358) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036.138198) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2017-05-18 |