| NPI | 1972565422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NH 15195) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT 0320000509) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NH 15195) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2019-09-09 |