| NPI | 1730575119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR DO194550) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC MTL003083) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2022-06-20 |