| NPI | 1457821936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD C-000-115-609-977) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2018-11-28 |