| NPI | 1811988108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 20390) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN MD20390) |
| 207L00000X Anesthesiology (Licence: TN 20390) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-12-13 |