| NPI | 1225307580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT019769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015576) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2023-12-24 |