| NPI | 1174979744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MO 2021031129) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021031129) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2016018234) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 125075445) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2021-12-07 |