| NPI | 1487625331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD00026153) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00026153) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-06-28 |