| NPI | 1518288828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NC 2012-00261) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2012-00261) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2012-00261) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2025-06-02 |