| NPI | 1649702317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DC MD048964) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101271406) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2021-12-30 |