| NPI | 1720078678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD00047514) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 10342) |
| 207L00000X Anesthesiology (Licence: WA MD00047514) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MT 10342) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2015-02-06 |