| NPI | 1992231492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MA 290819) |
| Additional Taxonomies | 2085R0001X (Licence: NH 22146) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2022-06-20 |