| NPI | 1609879527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TN 24209) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 24209) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TN 24209) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: KY 47671) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2018-10-11 |