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 |