NPI | 1700383528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20547) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
390200000X Student in an Organized Health Care Education/Training Program | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-04-09 |
Last Update Date | 2023-12-25 |