| NPI | 1912326497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS15910) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.013312) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2022-07-13 |