| NPI | 1003831454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AL 25607) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 25607) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: AL 25607) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-01-12 |