| NPI | 1255891503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 73612) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD476156) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-08-21 |