| NPI | 1679781793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 067138) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL 101816) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-02-23 |