| NPI | 1982875621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: FL OS10791) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT011288) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: PA OT011288) | |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2017-11-03 |