| NPI | 1356568406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301101968) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA RTP 001776) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-05-06 |