| NPI | 1053375329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MA 205009) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 205009) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: MA 205009) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MA 205009) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2011-09-21 |