| NPI | 1659891265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T8463) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX T8463) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 272312) | |
| Enumeration Date | 2017-06-24 |
| Last Update Date | 2022-09-09 |