| NPI | 1881199404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037501) |
| Additional Taxonomies | 2086S0129X (Licence: CO DR.0074857) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-09-16 |