| 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 (Licence: AZ 56159) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2013-04-16 | 
| Last Update Date | 2025-05-27 |