| NPI | 1407083207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: GA 69715) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 36789) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: SC 36739) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: SC 36739) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2020-03-09 |