| NPI | 1760872071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA 20A18092) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2021-07-07 |