| NPI | 1073977914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101274306) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX S6099) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-09-16 |