| NPI | 1578846077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60166864) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA NA00172505) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |