| NPI | 1871073114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084N0600X (Licence: IL 036.17503) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2026-06-30 |