| NPI | 1518939594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301503317) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD424157) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101251701) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-11-10 |