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 |