| NPI | 1679722052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 55876) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101247262) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2024-02-13 |