| NPI | 1033194584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0065935) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 82190) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MA 82190) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2015-09-11 |