NPI | 1457715302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0129X (Licence: UT 13991200-1205) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301112381) |
Enumeration Date | 2016-04-07 |
Last Update Date | 2025-03-06 |