| NPI | 1447474390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME109638) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: FL ME109638) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: NC 2011-00093) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME109638) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2024-05-16 |