| NPI | 1568072056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 148107) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS 911763) |
| Enumeration Date | 2020-08-09 |
| Last Update Date | 2021-02-10 |