| NPI | 1083078042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2020-0174) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: NM MD2020-0174) | |
| 207R00000X Internal Medicine (Licence: NM MD2020-0174) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: NM MD2020-0174) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2025-08-29 |