| NPI | 1740263011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 038234) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 038234) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-05-12 |