| NPI | 1760426787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA G68855) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA G68855) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA G68855) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-08 |