| NPI | 1164402392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TN 28699) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: TN 28699) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TN 28699) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2024-08-10 |