| NPI | 1568259927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT237908) |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2026-06-05 |