| NPI | 1831570043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 54241) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 54241) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: KY 54241) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2024-04-23 |