| NPI | 1982164372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA12876600) |
| Additional Taxonomies | 2086S0129X (Licence: CT 77740) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-01-06 |