| NPI | 1639345713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2009012502) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2009012502) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2018-06-28 |