| NPI | 1700415973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT 81161) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.150324) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-07-01 |