| NPI | 1063470045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 1196) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TN 12019) |
| 207Q00000X Family Medicine (Licence: TN 12143) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2007-12-07 |