| NPI | 1063809754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME148910) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL 148910) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2023-07-05 |