| NPI | 1770107989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: HI 22077) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-01-03 |