| NPI | 1164641494 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M9781) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M9781) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2021-04-12 |