| NPI | 1801026596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 55872) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 106990) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 56999) | |
| 207L00000X Anesthesiology (Licence: MN 56999) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 55872) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2017-05-02 |