NPI | 1467080622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T7700) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 11010) |
208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX t7700) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-03-31 |
Last Update Date | 2025-06-20 |