| NPI | 1912004649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 39210) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 39210) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2019-05-03 |