| NPI | 1770713711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S5546) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA 60658794) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WV 24877) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2025-05-30 |