| NPI | 1871829069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 5101017919) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI l1593593) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 5101017919) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2019-01-07 |