| NPI | 1518461383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: VT 042.0040463) |
| Additional Taxonomies | 2086S0129X (Licence: NY 346505) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-08-25 |