| NPI | 1396290946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AL 38439) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 81258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: AL 38439) | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2026-04-02 |