| NPI | 1407831092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MA 203361) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 203361) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2011-11-01 |