| NPI | 1528478260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 301097) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: HI MD-22253) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-03 |
| Last Update Date | 2022-07-14 |