| NPI | 1861522906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY FT393) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11012999S) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |