| NPI | 1306802061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: KY 37145) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 30785) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 30785) | |
| 207L00000X Anesthesiology (Licence: KY 37145) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 37145) | |
| 208VP0000X (Licence: TN 30785) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2026-01-09 |