| NPI | 1700450129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MI 5101028053) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101028053) |
| 208D00000X General Practice (Licence: MI 5101028053) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-07-13 |