| NPI | 1285805713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 66905) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: GA 66905) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: AL MD.30274) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 66905) | |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2017-07-03 |