| NPI | 1417040379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: MI 4301085055) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301085055) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: MI 4301085055) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 4301085055) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-11-02 |