| NPI | 1801045208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.010464) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2022-01-25 |