| NPI | 1710987615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 58770) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MA 58770) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NH 12648) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-03-04 |