| NPI | 1396308078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: MA 1020225) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 1020225) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-08-23 |