| NPI | 1205817525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 38503) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: IL 036112552) |
| 207L00000X Anesthesiology (Licence: KY 38503) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2012-09-04 |