| NPI | 1750454310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX E5355) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX E5355) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX E5355) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: TX E5355) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2011-10-28 |