| NPI | 1790340073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101275440) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA 80397) | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2026-01-27 |