| NPI | 1407050842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 5101016644) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101016644) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2022-09-20 |