| NPI | 1558305979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M5517) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101238938) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35090134) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-12-05 |