| NPI | 1821529355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WI 71372) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 71372) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 308613) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2023-11-26 |