NPI | 1497103832 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0129X (Licence: GA 105400) |
Additional Taxonomies | 2086S0129X (Licence: IL 036.165202) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109412) | |
Enumeration Date | 2016-05-26 |
Last Update Date | 2025-07-24 |