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 |