| NPI | 1013370717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX T9363) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A152887) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: WA MD61170608) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2023-03-10 |