| NPI | 1497690010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL R362-780-96-101-0) |
| Enumeration Date | 2026-04-21 |
| Last Update Date | 2026-04-21 |