| NPI | 1093903072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 49708) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP460) |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: DC MD040505) | |
| 208600000X Surgery (Licence: VA 0116019194) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019194) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2017-02-06 |