| NPI | 1962086157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 76736) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2024-05-22 |