| NPI | 1295797280 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301062688) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301062688) | 
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301062688) | |
| 208VP0000X (Licence: MI 4301062688) | |
| Enumeration Date | 2006-04-05 | 
| Last Update Date | 2009-04-17 |