| NPI | 1295199826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 21061) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 84305) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2021-06-22 |