| NPI | 1437809977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX W4416) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS20754) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-04-16 |