| NPI | 1083893713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 73500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD43272) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 73500) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2018-09-06 |