NPI | 1639523616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A173527) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A173527) | |
Enumeration Date | 2016-04-15 |
Last Update Date | 2021-11-16 |