| NPI | 1811921216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 35882) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 39772) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: KY 39772) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-08-22 |