| NPI | 1164865895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101264419) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101264419) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2023-03-08 |