| NPI | 1467748111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CT 55481) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 55481) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2018-06-26 |