| NPI | 1982437927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY I16738) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 060005164) |
| Enumeration Date | 2024-08-23 |
| Last Update Date | 2024-08-23 |