| NPI | 1588509723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KS 94-12803) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 390200000X) |
| Enumeration Date | 2026-04-22 |
| Last Update Date | 2026-06-19 |