| NPI | 1154825289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL 00000000000) |
| Additional Taxonomies | 208VP0000X (Licence: FL OS21002) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 000000000) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-05-13 |