| NPI | 1689825309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KY TP631) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Y00000X Otolaryngology (Licence: MN 52074) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: KY TP631) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2015-08-13 |