| NPI | 1417535287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0102208673) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102208673) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-08-13 |