| NPI | 1841493913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CT 047749) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101233575) |
| 2086S0129X (Licence: NY 243360) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2010-11-17 |