| NPI | 1518368141 |
|---|---|
| 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 |
| 174400000X Specialist | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2015-01-06 |