| NPI | 1417447798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T8919) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R77019) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-13 |
| Last Update Date | 2025-12-03 |