| NPI | 1164641494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX M9781) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M9781) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX M9781) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2025-06-18 |