| NPI | 1639639172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.258776) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC MMD.84429LL) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN28429) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2025-06-15 |