| NPI | 1770112609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: IA R-13014) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.078730) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-03-27 |