| NPI | 1629046842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 51119) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 051119) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 51119) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2013-05-16 |