| NPI | 1306258322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 4301500305) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301500305) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-25 |
| Last Update Date | 2023-06-30 |