| NPI | 1215460076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD MD049166) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MD D93702) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2022-08-02 |