| NPI | 1598084089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000051292) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT197893) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197893) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2022-03-22 |