| NPI | 1376978312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: FL OS15124) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 270268) |
| 207R00000X Internal Medicine (Licence: OH 58.004990) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL OS15124) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2021-01-19 |