| NPI | 1578761375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD44680) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN MD44680) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: KY MD44023) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2019-02-04 |