| NPI | 1710448659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL UO6788) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL UO6788) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS20010) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-05-09 |