| NPI | 1710412275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0102205433) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2081S0010X) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2022-08-16 |