| NPI | 1205194149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A126596) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63270) |
| 2081N0008X Physical Medicine & Rehabilitation Neuromuscular Medicine (Licence: CA A126596) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2016-07-26 |