| NPI | 1588923817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2015-00999) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2015-00999) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2025-05-02 |