| NPI | 1649731555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 05573) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP618) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-10-25 |