| NPI | 1659833234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX V1020) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX V1020) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX V1020) | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-06-06 |