| NPI | 1417934290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 29900) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 29900) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2025-05-14 |