| NPI | 1760002968 |
|---|---|
| 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: MN 76729) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-06-19 |