| NPI | 1558705301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX v4459) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 303320) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 303320) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2025-03-14 |