| NPI | 1639167091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A44356) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A44356) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A44356) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2020-11-02 |