| NPI | 1245618735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 283X00000X Rehabilitation Hospital |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2016-04-18 |