| NPI | 1649731951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 195564) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 295208) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-09-09 |