| NPI | 1124034137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 36569) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM 85-32) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NM 85-32) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-01-23 |