| NPI | 1619194842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 64313) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 64313) |
| 207L00000X Anesthesiology (Licence: GA 001010) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-04-10 |