| NPI | 1316389182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX R9458) |
| Additional Taxonomies | 2085R0001X (Licence: TN 57594) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2026-04-01 |