NPI | 1821315623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 54393) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 54393) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-05-03 |
Last Update Date | 2020-09-17 |