| NPI | 1467647370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME125192) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 26,507-R) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116024102) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2020-07-24 |