| NPI | 1619991643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 27636) |
| Additional Taxonomies | 251F00000X Home Infusion |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 27636) | |
| 208VP0000X (Licence: AZ 27636) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2026-08-20 |