| NPI | 1891163945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-09-07 |
| Last Update Date | 2018-08-02 |