| NPI | 1750875464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| 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: MA 276469) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2023-11-30 |