| NPI | 1710417100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 21474) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: PR 21474) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-08-29 |