| NPI | 1770825127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD61443248) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103007) |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA MD080910) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: DC MTL002296) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2023-08-31 |