| NPI | 1508201393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 89892) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 201801276) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301103471) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC MD52148) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2022-06-08 |