| NPI | 1366554917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 047130) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 047130) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-07-06 |