| NPI | 1972185759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL21-0897) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 303361) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2021-07-23 |