| NPI | 1154538353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA 41102) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME96764) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: IA 41102) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2013-09-05 |