| NPI | 1790159630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA PHAI.IR.60509130) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2015-11-16 |