| NPI | 1568586675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D69265) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0069265) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.090943) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301084066) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-06-10 |