| NPI | 1578596995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 20645) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 20645) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-12-09 |