| NPI | 1154393916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 30101) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 30101) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2015-01-28 |