NPI | 1801186614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 60637) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2011-04-13 |
Last Update Date | 2018-04-16 |