| NPI | 1629063904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 37055) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 37055) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 37055) | |
| 208VP0000X (Licence: KY 37055) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2023-01-09 |