| NPI | 1508218587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2016-10-28 |