| NPI | 1013279884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 55808) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 0056819) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2016-09-02 |