| NPI | 1194770115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 12719) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101036844) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2015-07-24 |