| NPI | 1841652013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A18732) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A18732) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-06-28 |