| NPI | 1154700011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 86021) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101021725) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 5101025390) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2020-10-28 |