| NPI | 1700059151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A102872) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A102872) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A102872) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 237555) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2021-12-13 |