| NPI | 1124531819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PR 22699) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: PR 22699) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2024-08-13 |