| NPI | 1497040141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P9854) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P9854) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2026-08-25 |