| NPI | 1730191123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 9800155) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 9800153) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2014-11-04 |