| NPI | 1407296650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 301845) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35.133928) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WV 28287) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2023-09-06 |