| NPI | 1568819712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 322015) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 1745.DO) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2024-03-21 |