| NPI | 1366821738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME147849) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 1366821738) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.139609) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2023-10-06 |