| NPI | 1902099864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0102203184) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: WV 1444) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0102203184) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2023-07-26 |