| NPI | 1649224676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: CT 039753) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 039753) |
| 207L00000X Anesthesiology (Licence: MA 158535) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: CT 039753) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: MA 158535) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2022-09-15 |