| NPI | 1114217908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MO 2016009811) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2016009811) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WA 60846740) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2020-05-21 |