| NPI | 1679552228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301110921) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A81701) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301110921) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2021-05-06 |