| NPI | 1679603690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY FT391) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11013005A) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |