| NPI | 1326019712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: AL 21871) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL 21871) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AL 21871) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2016-03-14 |