| NPI | 1780840751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P6501) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225100000X Physical Therapist (Licence: AL 5679) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2016-12-08 |