| NPI | 1740623388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX Q9878) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 17539) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10047555) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX Q9878) | |
| Enumeration Date | 2013-04-13 |
| Last Update Date | 2021-08-23 |