| NPI | 1255355467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ND 21450) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: ND 21450) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 31118) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2026-09-23 |