| NPI | 1871083006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: LA 340478) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: PA MT216638) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-07-22 |