| NPI | 1093125601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 62997) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 270770) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT 62997) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2022-10-03 |