| NPI | 1942341334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME100830) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0062043) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2010-12-21 |