| NPI | 1629698436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 2025-03260) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2025-03260) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 260634) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-09-12 |