| NPI | 1992067458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A147608) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A147608) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A147608) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-03-18 |