| NPI | 1255594909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 325040) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 45503) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: LA 325040) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A129760) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-01-19 |