| NPI | 1568859510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 85822) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA PGY.203100) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2020-06-18 |