| NPI | 1053563163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX N9109) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX N9109) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2018-10-29 |