| NPI | 1861788291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A13926) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT014044) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R2141) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-06-19 |