| NPI | 1609225762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ID M-16138) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR MD221988) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2026-07-08 |