| NPI | 1629767447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 3017578) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2026-0290) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2026-08-31 |