| NPI | 1912218686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 52828) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 62967) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2022-10-14 |