| NPI | 1083643654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CO 42833) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO 42833) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-01-08 |