| NPI | 1154825289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: FL OS21002) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS21002) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 000000000) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-07-15 |