| NPI | 1366522682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 77539) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ MA065962) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 22277) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 71747) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-06-09 |