| NPI | 1649210642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME73192) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME73192) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2015-04-07 |