| NPI | 1841650843 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 86833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15505) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL OS15505) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS15505) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2021-07-20 |