| NPI | 1841285442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MT 4154) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MT 4154) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MT 4154) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2008-09-09 |