| NPI | 1003102898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 076333) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: GA 076333) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 076333) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN16412) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2020-07-09 |