| NPI | 1295793271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 044014) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 044014) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-07-30 |