| NPI | 1649247958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: SC 11972) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 11972) |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2026-04-29 |