| NPI | 1649632183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 55535) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY TP095) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2021-06-11 |