| 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) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2025-05-27 |