| NPI | 1003928839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: WA MD00049125) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00049125) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-04-26 |