| NPI | 1487278875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2025-01885) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 11977) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0099403) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2025-07-01 |