| NPI | 1154329126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: MD MD21491) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: DC MD21491) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2020-02-03 |