| NPI | 1487034419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101270293) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.136334) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-03-14 |