| NPI | 1962736611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: CT 13633) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: PA MD-050916L) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: NY 60-18004) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: MA 154633) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: CT 013633) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: CA G88443) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 013633) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT 013633) | |
| 209800000X Legal Medicine (Licence: CT 013633) | |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2019-04-30 |