| NPI | 1922230507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 42850) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ R70503) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2020-08-03 |