| NPI | 1750539896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2009021574) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY p66930) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2009-11-05 |