| NPI | 1770902959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10834700) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 82188) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-11-15 |