| NPI | 1710501911 |
|---|---|
| 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: VA 0101286386) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-11-04 |