| NPI | 1578735999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 14341) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV paperwork in process) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2018-05-01 |