| NPI | 1568555795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 9801052) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 9801052) |
| 207L00000X Anesthesiology (Licence: NC 9801052) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-06-24 |