| NPI | 1427680784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 37495) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2026-05-27 |