| NPI | 1023040748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: CA A71934) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A71934) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: CA A71934) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-08-31 |