| NPI | 1316575657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX V2278) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-09-13 |