| NPI | 1861494023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA OS008858L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OS008858L) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2017-05-02 |