| NPI | 1154903169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 104847) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC SUGA-N8117R) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2025-08-26 |