| NPI | 1265411136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AL 00021633) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL 00021633) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 00021633) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-05-11 |