| NPI | 1952576506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY FT424) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11014147A) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-28 |