| NPI | 1538107305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 20094) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 38149) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 20094) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2013-08-29 |