| NPI | 1457920720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 9959) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 12562) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2025-10-01 |