| NPI | 1629139910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 41248) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME103759) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME103759) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD D0068314) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-07-19 |