| NPI | 1174902977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 101525-875) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 31580) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 68881) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 13580) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-02-09 |