| NPI | 1700854478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: ND PT13632) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA MD014915E) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD014915E) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2015-07-23 |