| NPI | 1851432819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 1593) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY 03255) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KY 03255) | |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2017-02-17 |