| NPI | 1912346461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD186805) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR MD186805) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2019-05-09 |