| NPI | 1679036347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 61521442) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-06-25 |