| NPI | 1922758614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 94-11710) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2023026722) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2024-06-24 |