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 | 2022-11-04 |