| NPI | 1750308664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NC 200201393) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NC 200201393) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: NC 200201393) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2021-09-14 |