| NPI | 1518386242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 67909) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11275969-1204) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: IL 125-064513) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-07-27 |