| NPI | 1821450248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: GA 92815) |
| Additional Taxonomies | 2085R0001X (Licence: RI MD17460) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.069887) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-07-26 |