| NPI | 1669844221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2022-03-25 |