| NPI | 1891724738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: TN 17581) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 17581) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MS 11868) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2023-02-08 |