| NPI | 1093805152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 27270) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 43679) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 27270) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-05-14 |