| NPI | 1215170204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2016-01841) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101256526) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2016-09-07 |