NPI | 1700401866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS20833) |
Additional Taxonomies | 208D00000X General Practice (Licence: FL OS20833) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-06-14 |
Last Update Date | 2024-05-28 |