| NPI | 1871574194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: CT 46575) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 43525) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NJ DO1392) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2018-11-01 |