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 |