| NPI | 1316905847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 5101009511) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101009511) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2017-02-09 |