| NPI | 1205989605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301055514) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301055514) |
| 208D00000X General Practice (Licence: MI 4301055514) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301055514) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2022-11-29 |