| NPI | 1184609356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WI 37593-020) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 37593-020) |
| Enumeration Date | 2005-12-10 |
| Last Update Date | 2014-01-29 |