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 |