| NPI | 1477602795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NH 9752) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NH 9752) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2014-06-18 |