| NPI | 1407198807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MI 4301116716) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 4301116716) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2021-05-05 |