| NPI | 1518272293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA NOT APPLICABLE) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2010-08-18 |