| NPI | 1326453176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 294993) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4307) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2021-07-28 |