| NPI | 1902458250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 35728R) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 35194R) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 34535R) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2021-08-06 |