| NPI | 1841654209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 14195) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-04-04 |