| NPI | 1780665828 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 020437)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA MD020437)  | 
| Enumeration Date | 2005-11-07 | 
| Last Update Date | 2013-07-02 |