| NPI | 1932696713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA DO.OP.61425189) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005638A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2026-07-06 |