| NPI | 1003259896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MS 28313) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: LA 309355) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2023-03-27 |