| NPI | 1821000613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT CT029832) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 029832) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 029832) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-04 |