| NPI | 1962727933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 26425) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 63788) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2022-07-21 |