| NPI | 1023045309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A9285) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: CA 20A9285) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 20A9285) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2023-03-07 |