| NPI | 1992021216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: VA 0102203992) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102203992) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0102203992) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2025-05-14 |