| NPI | 1205876513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301085355) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX Q5156) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-01-05 |