| NPI | 1619437605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX U4883) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10070647) |
| 207R00000X Internal Medicine (Licence: IL 125.074558) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-07-27 |