| 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 |