| NPI | 1992789390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 23846) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 23846-020) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2012-04-04 |