| NPI | 1942696877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME145194) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME145194) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2020-06-02 |