| NPI | 1366700932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2017-011555) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2017-01155) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2022-05-16 |