| NPI | 1205911518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 0000014982) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN MD14982) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2017-01-10 |