| NPI | 1003479221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS20017) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS021606) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-09-08 |