| NPI | 1245239375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR MD25091) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD25091) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD25091) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OR MD25091) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2026-05-22 |