| NPI | 1801479092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W3804) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208VP0000X (Licence: TX W3804) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX W3804) | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2026-05-01 |