| NPI | 1679514145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MO R5P16) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO R5P16) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2012-05-09 |