| NPI | 1215919485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL me103262) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 35429) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 35429) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2019-08-27 |