| NPI | 1629654132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA DO-06944) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-03-08 |