| NPI | 1912118514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301088201) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301088201) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD D73216) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MP 4301088201) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-10-30 |