| NPI | 1598298143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MD049108) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT212600) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2021-07-02 |