| NPI | 1124413554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA MD-47576) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML60563960) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-10-11 |