| NPI | 1265530463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WI 39918) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME90441) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME90441) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME90441) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-03-28 |