| NPI | 1740129030 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-12941) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2026022690) |
| Enumeration Date | 2026-03-25 |
| Last Update Date | 2026-06-30 |