| NPI | 1013411032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2023-01421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 238130) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116032519) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-07-25 |