| NPI | 1013201938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A122544) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA A122544) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2016-04-22 |