| NPI | 1295959823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: ND 11173) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2008-01684) |
| 207L00000X Anesthesiology (Licence: OH 35-092694) | |
| 207L00000X Anesthesiology (Licence: ND 11173) | |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: ND 11173) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: ND 11173) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-03-07 |