| NPI | 1700672771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT236447) |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2026-05-04 |