NPI | 1063932580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 95898) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 34.015576) |
208D00000X General Practice (Licence: FL OS15517) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-06-26 |
Last Update Date | 2023-08-07 |