| NPI | 1720327760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD B-230-367-135-386) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2013-02-12 |