| NPI | 1699356857 |
|---|---|
| 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: CA A188026) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2024-06-20 |