| NPI | 1366673626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 207103) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: LA MD.207103) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2021-03-30 |