| NPI | 1821799099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD 1821799099) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 1821799099) | |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2024-07-09 |