| NPI | 1033503255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10420400) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 296383-1) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IN 02005347A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2019-04-30 |