| NPI | 1679077903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 69389) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 69389) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 69389) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-07-31 |