| NPI | 1912217613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 24020) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI PHL03722) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2010-10-14 |