| NPI | 1144752411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 84976) |
| Additional Taxonomies | 208VP0000X (Licence: GA 84976) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 84976) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2026-04-07 |