NPI | 1174084123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD481663) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-03-30 |
Last Update Date | 2024-10-23 |