NPI | 1972906915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251V00000X Voluntary or Charitable |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 03Qy679) |
Enumeration Date | 2014-10-05 |
Last Update Date | 2014-10-05 |