| NPI | 1982994745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 44807) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 44807) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2020-02-06 |