| NPI | 1659804979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 338490) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 338490) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: LA 338490) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME157022) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-04-21 |