| NPI | 1922216308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101260343) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101260343) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2019-10-31 |