| NPI | 1063665719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: UT 8728465-1204) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10031712) |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: MO 2011017820) | |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: UT 8728465-1204) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2021-12-10 |