| NPI | 1245265206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: WV 18714) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 18714) |
| 207L00000X Anesthesiology (Licence: VA 0101054348) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101054348) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WV 18714) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101054348) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2016-10-24 |