| NPI | 1588891428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NC 2014-00510) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2014-00510) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 157536) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2016-02-05 |