| NPI | 1548758279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.016518) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS021696) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2023-10-11 |