| NPI | 1043357452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2003022490) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2003022490) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2026-02-14 |