| NPI | 1629239553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA C163168) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35094657) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2020-12-16 |