| NPI | 1639140866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL OS9421) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 5101023532) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS9421) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2022-08-31 |