| NPI | 1265625321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 93018) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: OH 35-06-3329) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME105674) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2024-10-04 |