| NPI | 1891548343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 37240) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL TRN41896) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-05-12 |