| NPI | 1174059182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 87926) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 87926) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-12-20 |