| NPI | 1154733285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 5101024603) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101024603) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2019-08-01 |