| NPI | 1821478744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10536200) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB10536200) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT016359) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2021-04-28 |