| NPI | 1437684008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 70656) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 1437604008) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 1437604008) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2022-08-24 |