| NPI | 1700317336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME174562) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301500696) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IN 01093231A) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2026-04-20 |