| NPI | 1265819577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 283962) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301107103) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107103) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2020-09-14 |