| NPI | 1780634691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 94001169400116) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 9400116) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-07-10 |