| NPI | 1821233735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PR 23707) |
| Additional Taxonomies | 2086S0129X (Licence: FL ME132528) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2025-09-18 |