| NPI | 1255421467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: OR MD29376) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 48838020) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2015-12-03 |