| NPI | 1902265937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA AT002768) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 1807) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2016-02-18 |