| NPI | 1316327778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA DO-05813) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX S2465) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-09-16 |