| NPI | 1932563723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 021902) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME151503) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-04-17 |