| NPI | 1528022050 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 023125) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 023125) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2018-09-13 |