| NPI | 1972575215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME78743) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME78743) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2023-03-07 |