| NPI | 1477965622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT MED-RES-LIC 52155) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2016-12-19 |