| NPI | 1720377856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A168740) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 276415) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2025-08-28 |