| NPI | 1487034419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: IA MD-53539) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.136334) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101270293) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2025-04-03 |