| NPI | 1811308828 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 65728) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MS T-2795) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2022-03-24 |