| NPI | 1679569685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 18915) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 18915) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 18915) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2018-03-15 |