| NPI | 1104884279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: NC 34813) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 00-34813) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 34813) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-08-17 |