| NPI | 1407358880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 05243) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP806) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2022-06-22 |