| NPI | 1902244114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AL MD.36799) |
| Additional Taxonomies | 2085R0001X (Licence: IN 01080530A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017281A) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2018-10-09 |