| NPI | 1588012140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 05002) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY R4002) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2021-06-25 |