| NPI | 1033573126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: TX T8264) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: CA A168524) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10055696) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2022-07-17 |