| NPI | 1952594160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME106459) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 54764) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2024-04-11 |