| NPI | 1902937105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-03-23 |