NPI | 1053391250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101226429) |
Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101226429) |
Enumeration Date | 2006-01-23 |
Last Update Date | 2021-03-10 |