| NPI | 1114386463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD481929) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301505462) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2023-08-10 |