| NPI | 1700047669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 20A11607) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: CA 20A 11607) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2015-09-10 |