| NPI | 1336502079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A20305) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A20305) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 68200) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A20305) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-11-07 |