| NPI | 1134657943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T8744) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX T8744) | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2024-01-08 |