| NPI | 1013911361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD157375) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A75659) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD00048162) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2014-10-29 |