| NPI | 1790737799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD214569) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301066286) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301066286) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-06-05 |