| NPI | 1770106304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046205) |
| Additional Taxonomies | 2086S0129X (Licence: MI 4301510116) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2025-08-05 |