| NPI | 1033572821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX V2223) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 30164) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2025-08-15 |