| NPI | 1780636969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 23153) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 282N0000X) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 23153) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-06-25 |