| NPI | 1326092610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.200758) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA MD.200758) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: LA 200758) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2014-12-10 |