NPI | 1104453166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2025028099) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-03-26 |
Last Update Date | 2025-07-30 |