| NPI | 1851788772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NY 333249) |
| Additional Taxonomies | 2085R0001X (Licence: WA MD.MD.61311208) |
| 2085R0001X (Licence: MD aj4147357-v5548) | |
| 2085R0001X (Licence: NJ 25MA10846900) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2025-06-02 |