| NPI | 1184088908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX T3408) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0129X (Licence: TX BP10056957) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-07-14 |