| NPI | 1881272011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2086S0129X (Licence: NJ 25MA13169500) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-06-15 |