| NPI | 1255304655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 20707) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 20707) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 20707) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-04-25 |