| NPI | 1629103759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0067548) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME152091) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101252873) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD446984) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2024-01-17 |