| NPI | 1720069669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: RI MD12234) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MA 222796) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: RI MD12234) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX M3568) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CT 045009) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2013-01-04 |