| NPI | 1235457235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD457824) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197462) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197462) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2022-11-11 |