| NPI | 1275117624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX W7454) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TX W7454) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX W7454) | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2026-07-23 |