| NPI | 1790831394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO 50678) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD 60085744) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 1999) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2013-08-05 |