| NPI | 1518353192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD.61122723) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D0089143) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD D0089143) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-05-20 |