| NPI | 1316500937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP20069820) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX BP10067101) |
| 207R00000X Internal Medicine (Licence: TX BP10067101) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2024-04-01 |