| NPI | 1104567825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WY 18741A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 18741A) |
| 207R00000X Internal Medicine (Licence: MT 160535) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MT 160535) | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-08-04 |