| NPI | 1891883765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 060819) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: SC LL24087) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: GA 060819) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NC 2007-01110) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2023-01-11 |