| NPI | 1730178799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 20670) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 20670) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2012-09-04 |