| NPI | 1841679768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D89558) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 82481) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 82481) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-03-02 |