| NPI | 1417963307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0050277) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: MD D0050277) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-05-22 |