| NPI | 1255395851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MA 229003) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 218984) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 229003) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2013-02-18 |