| NPI | 1538717129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 261QR1100X Clinic/Center, Research |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2021-03-22 |