| NPI | 1770587016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TX J0823) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J0823) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX J0823) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-12-28 |