| NPI | 1194189845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MT MED-PHYS-LIC-90297) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63798) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2021-03-22 |