| NPI | 1669908125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IN 01088288A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 664384) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2022-09-26 |