| NPI | 1568794824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA C153716) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101246756) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101246756) | |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2023-05-01 |