| NPI | 1548585417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: CA G136863) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D30413) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2020-08-10 |