| NPI | 1790537629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0001X (Licence: MN 34944) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2025-04-29 |