| NPI | 1396063194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301108683) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 61010) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101256052) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2023-11-03 |