| NPI | 1326245606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC Pending) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018195) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC Pending) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2011-07-05 |