| NPI | 1093071482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: TX R2409) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX R2409) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 39283) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2022-01-28 |