| NPI | 1861504417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 041103) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 041103) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-01-24 |