| NPI | 1700864170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC MD 36305) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 11092) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NH 11092) | |
| 207L00000X Anesthesiology (Licence: SC MD36605) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2013-01844) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2017-03-28 |