| NPI | 1376697045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX M9530) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX M9530) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2017-05-22 |