| NPI | 1033590807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IA DO-05482) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NE 7436) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-10-18 |