NPI | 1831650043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA OP61483972) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2023000432) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2020011741) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-03-29 |
Last Update Date | 2024-06-24 |