| NPI | 1902154305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD456997) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NV 17101) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2020-01-22 |