| NPI | 1861645921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME 106449) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 104554) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 52325) | |
| Enumeration Date | 2008-11-02 |
| Last Update Date | 2010-07-08 |