| NPI | 1154712057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 008051) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS15478) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2020-11-09 |