| NPI | 1689086019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME141511) |
| Additional Taxonomies | 2085R0001X (Licence: IL 036158175) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2025-01-07 |