| NPI | 1871851154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD61471022) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61471022) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD61471022) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2023-09-29 |