| NPI | 1538861919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R82360) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 17564I) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-04-30 |