| NPI | 1285165787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO DR.0076301) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R4577) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 55214) | |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2025-10-14 |