| NPI | 1659878833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A19883) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11420218-1204) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-07-13 |