| NPI | 1285165787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 55214) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R4577) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2023-03-02 |