| NPI | 1710963681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AK MEDS6318) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 4476) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-03-31 |