| NPI | 1790027167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX R6627) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX R6627) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: TX R6627) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2020-05-20 |