| NPI | 1962868117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 60286362) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ID E33922) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |