| NPI | 1013477926 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD D0101092) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0101092) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 | 
| Last Update Date | 2025-07-29 |