| NPI | 1679554323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AR E-19167) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MS 16017) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2025-09-30 |