| NPI | 1699271049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX U0434) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 322926) |
| 208D00000X General Practice (Licence: LA 322926) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2022-12-01 |