| NPI | 1275087686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX U1766) |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2024-03-04 |