| NPI | 1730129719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A80840) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A80840) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A80840) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2017-04-05 |