| NPI | 1851956569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101289111) |
| Additional Taxonomies | 2086S0129X (Licence: CA A180889) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2026-05-26 |