| NPI | 1407884984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 55475-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD420567) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD420567) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD420567) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 55475-20) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-11-30 |