| NPI | 1851619993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS21335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 11023156A) |
| 225100000X Physical Therapist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2024-11-23 |