| NPI | 1952508665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 66464) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT011928) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2020-04-14 |