| NPI | 1578096293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 00000000000000000000) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |