| NPI | 1346515020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL OS13636) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA OS018248) | |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2022-03-24 |