| NPI | 1417933938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA G68169) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G68169) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2011-04-12 |