| 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 |