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 |