| NPI | 1386629822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA MD426845) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD426845) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2020-03-05 |