| NPI | 1558999243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 25364) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV LL3569) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-06-26 |