| NPI | 1174578801 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301058720) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301058720) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2014-03-25 |