| NPI | 1124153754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX M5545) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX M5545) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2016-01-04 |