| NPI | 1205213287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: HI DOS-2068) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A15138) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-05-26 |