| NPI | 1689296386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: FL 170000) |
| Additional Taxonomies | 2080H0002X (Licence: IL 036.164936) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2024-08-17 |