| NPI | 1205253671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301117305) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: MI 4301117305) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301117305) | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2025-07-03 |