| NPI | 1306405444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD481761) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT218917) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-09-05 |