| NPI | 1609824895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A101856) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 21390) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WV 21390) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2010-09-20 |