| NPI | 1699744185 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301065963) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301065963) |
| 207L00000X Anesthesiology (Licence: MI 4301065963) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-11-06 |