| NPI | 1932469350 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 34321) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301100660) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100660) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2024-12-20 |