| NPI | 1194967703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 62099-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 62099-20) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2021-01-19 |