| NPI | 1164788311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX Q3612) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q3612) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2025-01-03 |