| NPI | 1558623520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 66467-20) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 66467-20) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 66467) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-03-09 |