| NPI | 1376907782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35.144094) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2020-00386) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-08-02 |