| NPI | 1659603090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL 149225) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9908) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME149225) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN27653) | |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2022-10-26 |