| NPI | 1326466616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: ID O-1255) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 259897) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2019-09-12 |