| NPI | 1639606379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OR MD209685) |
| Additional Taxonomies | 2085R0001X (Licence: IL 125071100) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2025-06-06 |