| NPI | 1215000468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 40919) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 229853) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 25014) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2026-03-02 |