| NPI | 1609142694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 56335) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT 5635) |
| 208VP0000X (Licence: CT 56335) | |
| Enumeration Date | 2012-03-24 |
| Last Update Date | 2022-03-11 |