| NPI | 1649687914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NV 23270) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 23270) |
| 207L00000X Anesthesiology (Licence: NM MD2019-0248) | |
| 207L00000X Anesthesiology (Licence: UT 9610007-1205) | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2024-03-15 |