| NPI | 1104988328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101245237) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT186418) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101245237) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0101245237) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-03-27 |