NPI | 1760060784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 327278) |
Additional Taxonomies | 208D00000X General Practice (Licence: LA 333171) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-03-31 |
Last Update Date | 2023-08-30 |