| NPI | 1861716888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.205120) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2014-01-29 |