| NPI | 1245214212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX M9852) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M9852) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2016-03-09 |