| NPI | 1568106680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171W00000X Contractor (Licence: MO 2020010630) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2022-04-25 |