| NPI | 1942596424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME142452) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 286142) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-06-06 |