| NPI | 1336609718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 91310) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD480729) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2024-07-17 |