| NPI | 1720125131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 030873) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 030873) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 030873) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2014-06-18 |