| NPI | 1396004594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA 20A15212) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MI 5101019962) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 5101019962) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2023-09-26 |