| NPI | 1992931711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD60491842) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: WA 60491842) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2016-12-08 |