| NPI | 1871989301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 53001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 53001) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2020-09-08 |