| NPI | 1194778852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: FL OS9725) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: FL OS9725) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL OS9725) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-04-21 |