| NPI | 1962698654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 42472) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 53982) |
| 207L00000X Anesthesiology (Licence: UT 6351856-1205) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 53982) | |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2022-11-08 |