| NPI | 1710349147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: TX S2562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 291656) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-06-13 |