| NPI | 1679552376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 83155) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 11795) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 83155) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NH 11795) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2022-07-19 |