| NPI | 1245499060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CA 174837) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: FL ME116759) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2021-10-28 |