| NPI | 1184200610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101288593) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049523) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: IA MD-56342) | |
| 207P00000X Emergency Medicine (Licence: VA 0101288593) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-07-29 |