| NPI | 1326366832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: AZ 50520) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: AZ 50520) |
| 207L00000X Anesthesiology (Licence: UT 9017935-1205) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 50520) | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2021-06-04 |