| NPI | 1104007319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2009-01646) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2009-01646) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 32468) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2015-07-21 |