| NPI | 1770012619 |
|---|---|
| Former Name | KONSTANTIN VIKTOROVITCH KOROTKOV |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA FE60762184) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2017-09-15 |