| NPI | 1659866945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME179181) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN27316) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2026-07-13 |