| NPI | 1578726592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 201000903) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2010-00903) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2018-01-10 |