| NPI | 1154307437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301060749) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301060749) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2012-10-09 |