| NPI | 1952613101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X (Licence: OH 35.131182) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11015668A) |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2018-10-22 |