| NPI | 1447954573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC VANHOUZEN03041994) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |