| NPI | 1922414911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 51529) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 51529) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 51529) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 51529) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2022-12-13 |