| NPI | 1649652512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 66338-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66338-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2022-05-06 |