| NPI | 1831322189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P5827) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 57125) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2022-01-26 |