| NPI | 1720371602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: ND 14140) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND 14140) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: ND 14140) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ND 14140) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2021-09-09 |