| NPI | 1205996501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA 20A8461) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 20A 8461) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 20A 8461) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2011-05-18 |