| NPI | 1265894000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA DO-06167) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.012979CTR) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-12-01 |