NPI | 1912118514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301088201) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MP 4301088201) |
208100000X Physical Medicine & Rehabilitation (Licence: MD D73216) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2007-05-24 |
Last Update Date | 2015-12-11 |