| NPI | 1972998516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 87063-20) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 35993) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD477447) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2026-09-14 |