| NPI | 1518457258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 69844) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 314832-01) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 69844) | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2023-10-26 |