| NPI | 1376047837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX V1351) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD61258608) |
| 207L00000X Anesthesiology (Licence: WI 4373-320) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-04-10 |