| NPI | 1336546084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T2161) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2018010998) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2023-01-26 |