| NPI | 1205074002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL 123792) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME123792) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME123792) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 236756) | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2023-10-27 |