| NPI | 1720494537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 52769) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 52769) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 52769) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-09-11 |