| NPI | 1801821962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 35843) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 35843) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-12-24 |