| NPI | 1013228402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 33148) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 9491) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 54608) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NE TEP 6392) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2026-01-31 |