| NPI | 1811978976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD00040503) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD00040503) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2018-06-28 |