| NPI | 1699118943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 56159) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 56159) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 56159) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2023-05-04 |