| NPI | 1679983050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301114538) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301114538) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2022-04-04 |