| NPI | 1023049418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME166876) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 1802048905) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: UT 1802048905) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 180204-1205) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2026-05-06 |