| NPI | 1376869396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX Q6891) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036141626) |
| 207R00000X Internal Medicine (Licence: MI L1761511) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 5699) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2020-09-02 |