| NPI | 1265668453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 60282) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 60282) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2023-05-19 |