| NPI | 1548368459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PR 9945) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 9945) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-11-30 |