NPI | 1801451653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX U3380) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-05-07 |
Last Update Date | 2024-07-03 |