| NPI | 1114984358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101055618) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101055618) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101055618) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-06-10 |