| NPI | 1861533291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 061303) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 061303) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 061303) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2011-12-19 |