| NPI | 1669091260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2025-03054) |
| Additional Taxonomies | 208VP0000X (Licence: NC 2025-03054) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-10-18 |