| NPI | 1235872342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351049533) |
| Enumeration Date | 2022-04-16 |
| Last Update Date | 2023-05-02 |