| NPI | 1114589165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5151013704) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 51-51013704) |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2020-06-27 |