| NPI | 1649604695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WI 72673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 8295472) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2020-10-28 |