| NPI | 1265939581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WA OP61392698) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WA OP61392698) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-05-06 |