| NPI | 1659728822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 1659728822) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-08-29 |