| NPI | 1518402015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: PR 23681) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T0321) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2024-07-03 |