| NPI | 1285994699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60776326) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A140976) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100659) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2021-04-16 |