| NPI | 1336559830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: WV 30762) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 82628) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NC 202000235) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2021-12-15 |