| NPI | 1811960560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD045440L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD045440L) |
| 207L00000X Anesthesiology (Licence: NY 199264-1) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 199264-1) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD045440L) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 199264-1) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2021-03-08 |