| NPI | 1497796858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A52751) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA A52751) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA A52751) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-07-21 |