| NPI | 1104269711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: WA MD60835773) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 60835773) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: WA 60835773) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-12-14 |