| NPI | 1841501004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q1520) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 54297) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-05-13 |