| NPI | 1780066878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX S5395) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX S5395) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-09-10 |