| NPI | 1962898031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: GA 90526) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME148033) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2023-08-31 |