| NPI | 1508000332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA L071618) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: GA 071618) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: GA 071618) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2014-10-22 |