| NPI | 1538736715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2025-01207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN33604) |
| 207P00000X Emergency Medicine (Licence: FL 33604) | |
| 207P00000X Emergency Medicine (Licence: VA 0101283026) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2025-09-23 |