| NPI | 1407836232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME79847) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME79847) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME79847) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2021-03-30 |