| NPI | 1659875532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 56800) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 56800) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-10-05 |