| NPI | 1649624248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64568) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 64568) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2021-08-25 |