| NPI | 1710245964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 302153) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: LA 302153) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2018-03-29 |