| NPI | 1801344809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2016011080) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2016011080) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-09-19 |