| NPI | 1003860636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: IA 35492) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA 35492) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: IA 35492) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2012-01-06 |