| NPI | 1992937676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 308405) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 46637) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 069064) | |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2019-07-11 |