| NPI | 1922234970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME MD20241) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 8572663-1205) | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2014-11-04 |