| NPI | 1144752411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 84976) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QS0010X Family Medicine, Sports Medicine (Licence: GA 84976) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 84976) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-02-29 |