| NPI | 1962473496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 9601527) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 9601527) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-08-25 |