| NPI | 1043833841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 20A20323) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20323) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-11-30 |