| NPI | 1851619993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 11023156A) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2023-07-22 |