| NPI | 1427897263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS23816) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OS23816) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2026-07-14 |