| NPI | 1619557733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME176603) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 41832) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-11-04 |