| NPI | 1215496484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 330329) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 330329) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-09-18 |