| NPI | 1710915350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: HI MD-4869) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: HI MD4869) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: HI MD4869) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2009-09-24 |