| NPI | 1154645653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX Q6158) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA 1154645653) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA A119507) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2020-02-10 |