NPI | 1194976357 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0101255168) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2008-10-07 |
Last Update Date | 2021-03-30 |