| NPI | 1124482740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX T0913) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS020213) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T0913) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2021-07-30 |