| NPI | 1952765323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101271811) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 277476) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101271811) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-05-21 |