| NPI | 1417243338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX Q3974) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: TX Q3974) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2016-09-29 |